Lunchtime pandemic reading.
Standard disclaimer: this is a roundup of informative pieces I've read that interest me on the severity of the crisis and how to manage it. I am not a qualified medical expert in ANY sense; at best I am reasonably well-read laity. ALWAYS prioritize advice from qualified healthcare experts over some person on Facebook.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.
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Today marks the one-year anniversary of me leaving my house in any significant way. One year ago I traveled to Social Media Marketing World in San Diego, my last business trip and the last time I traveled more than 10 miles away from my home. In a call last week with a friend, we noted that we're often thinking back to events that happened in 2019 and not remembering that that was TWO years ago, not last year. If you're finding a bit of the same temporal fog, you're not alone.
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Push for... up the nose! "The development of highly effective COVID vaccines in less than a year is an extraordinary triumph of science. But several coronavirus variants have emerged that could at least partly evade the immune response induced by the vaccines. These variants should serve as a warning against complacency—and encourage us to explore a different type of vaccination, delivered as a spray in the nose. Intranasal vaccines could provide an additional degree of protection, and help reduce the spread of the virus.
Although injected vaccines do reduce symptomatic COVID cases, and prevent a lot of severe illness, they may still allow for asymptomatic infection. A person might feel fine, but actually harbor the virus and be able to pass it on to others. The reason is that the coronavirus can temporarily take up residence in the mucosa—the moist, mucus-secreting surfaces of the nose and throat that serve as our first line of defense against inhaled viruses. Research with laboratory animals suggests that a coronavirus infection can linger in the nose even after it has been vanquished in the lungs. That means it might be possible to spread the coronavirus after vaccination.
Enter the intranasal vaccine, which abandons the needle and syringe for a spray container that looks more like a nasal decongestant. With a quick spritz up the nose, intranasal vaccines are designed to bolster immune defenses in the mucosa, triggering production of an antibody known as immunoglobulin A, which can block infection. This overwhelming response, called sterilizing immunity, reduces the chance that people will pass on the virus.
Yet among the hundreds of coronavirus vaccine candidates that are in various stages of development around the world, only a small fraction are intranasal. So far, they have not received large-scale government support. But the early research and development efforts focused on the mucosal route do appear to be promising.
In a study using laboratory animals, an experimental intranasal vaccine created by scientists at the Washington University School of Medicine induced a powerful immune response in both the mucosa and the rest of the body, almost entirely preventing infection. Another animal study further demonstrated the important role of the mucosa in preventing infection. The researchers developed an intranasal spray that made it difficult for the coronavirus to attach to human cells. Used daily, it was able to entirely block transmission of the virus. At least four intranasal vaccines have progressed to the first phase of clinical testing with people, in China, India, the U.K., and the U.S.
We will bring the COVID pandemic under control when we successfully reduce the spread of the coronavirus to extremely low levels. But the presence of vaccinated asymptomatic carriers could make this very difficult to do. For this reason, it seems imperative that new investments in vaccine research and development include substantial funding for intranasal vaccines. With their potential to block coronavirus infection—and with many fewer distribution and administration hassles—intranasal vaccines appear to be a smart bet. It is time to make them a priority, and accelerate their development."
Source: https://www.scientificamerican.com/article/to-beat-covid-we-may-need-a-good-shot-in-the-nose/
Commentary: I'm personally not a fan of needles. I dislike them strongly (but I will get my vaccination when it's time!) so if you were to offer me an option to take an intranasal spray for 28 days or get a shot in one day, I'd gladly shove that bottle far up my nose every day with glee. More important, an intranasal spray could be prophylactic - dose yourself the morning before you go to the grocery store or traveling on an airplane, and you'll add additional layers of protection beyond the shot in the arm.
I hope these efforts take root and we're all huffing COVID-19 vaccine fumes in a year.
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To be clear, all vaccines currently approved stop 100% of deaths and almost all hospitalizations.
"Folks—J&J vaccine is not “inferior”. It gives 100% protection against deaths just like Pfizer and Moderna ones. 72% in US overall—but was tested in a different era with more variants. And faster deployment for poorer areas, but worries about perception.
2) “Decisions to send the shots to harder-to-reach communities make practical sense, because j&j single-shot vaccine is easier to store/use. But they could drive perceptions of a two-tiered vaccine system, w/ marginalized communities getting what they think is inferior product.
3) “The issue came up on a recent call between governors and Biden administration officials coordinating the country’s coronavirus response. Gov. Charlie Baker, stressed the need for prominent health officials to communicate clearly about the benefits of the one-shot vaccine
4) “The Johnson & Johnson vaccine proved safe and effective in a clinical trial, completely preventing hospitalization and death, including in South Africa against a more transmissible variant.
5) “When moderate cases were included, however, it was 66 percent protective, compared to efficacy of more than 90 percent reported for a vaccine jointly developed by U.S. pharmaceutical giant Pfizer and German biotech firm BioNTech and one from U.S. biotech company Moderna...
6) “Trials were conducted at different points during the pandemic, and in different countries with different transmission rates, which makes head-to-head comparisons impossible.”
7) “The apparent differences, Baker said, could nonetheless create uncomfortable questions for state and local leaders promoting the new vaccine to people who might ask, as one person paraphrased his comments, “Why didn’t you give us the good stuff?”
8) ““J&J is going to be a challenge for all of us,” WA Gov Jay Inslee.
In N Dakota, which has achieved one of the fastest rates of inoculation, Gov. Burgum said the new product intensified concerns not just about “vaccine hesitancy, but the potential for brand hesitancy as well.”
9) “The problem has been on display in Germany, where some residents are shunning shots developed by AstraZeneca in favor of those made by Pfizer-BioNTech, because of the different levels of protection reported in clinical trials, according to officials there.
10) “If we end up with a hierarchy that says all rich White people get Pfizer, and all poor Black people get J&J, that would be a problem,” said Helene D. Gayle, president and chief executive of the Chicago Community Trust
11) Also let’s look at the direct data given to the FDA... For severe outcomes it was 85% with 95% CI upper bound up to 96.9%. Hence it overlaps with the higher values for Pfizer and Moderna. This lower value seen for J&J could still be roughly comparable!"
Source:
Commentary: Here's the thing. The COVID-19 vaccine - any of them - is not a one and done deal. It's not like measles, where you never get another shot for it. It's going to be very much like a flu shot, where you have to get a booster every year. Right now, forget about the 'brand' of shot and just get something, anything certified into your body. If Pfizer is what they have, take Pfizer. If J&J is what they have, take J&J. All of the current vaccines stop 100% of deaths, and almost all severe cases. You WILL be getting future shots, so you can always ask for your favorite brand in 2022 when inventory is plentiful. Heck, if you really care, you can probably get your favorite brand name at the end of 2021 as we'll likely be begging people to get a shot by that point.
There is absolutely a question of racial equity involved in vaccination, but if it's certified effective, take what you can get as soon as you can get it, and "upgrade" later when supply is no longer a problem.
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In America, vaccination is also showing signs of inequity. "It’s a fact that simply being eligible for a vaccine in America doesn’t mean that you can instantly get one. Yet the ability to get to the front of the line isn’t the same for everyone. ProPublica has found that, whether intentionally or not, some vaccine programs have been designed with inherent barriers that disadvantage many people who are most at risk of dying from the disease, exacerbating inequities in access to health care.
In many regions of the U.S., it’s much more difficult to schedule a vaccine appointment if you do not have access to the internet. In some areas, drive-through vaccinations are the only option, excluding those who do not have cars or someone who can give them a ride. In other places, people who do not speak English are having trouble getting information from government hotlines and websites. One state is even flat-out refusing to allow undocumented workers with high-risk jobs to get prioritized for vaccination.
“My nightmare scenario is that we have this two-tiered health system where there are people who are wealthy, privileged or connected, and then there's everybody else,” Dr. Jonathan Jackson, director of the Community Access, Recruitment, and Engagement Research Center at Massachusetts General Hospital and Harvard Medical School, told ProPublica. “Once we hit that saturation point where the first tier has all gotten their vaccines, the narrative will shift to blame. It'll be ‘Why haven't you taken care of this yet?’”
According to data from the Centers for Disease Control and Prevention, about 14% of adults in Florida have disabilities that affect mobility, which the CDC defines as serious difficulty walking or climbing stairs. While some people with mobility limitations may be able to access a car more easily than Balboa, he and his family were left with very few options.
Source: https://www.propublica.org/article/how-inequity-gets-built-into-americas-vaccination-system
Commentary: All governments need to make vaccination equally accessible and equitable if we want the pandemic to end sooner rather than later. The longer it takes for the population to get vaccinated, the more chances we give the virus to mutate and develop more dangerous variations, including variants that can elude vaccines. Be sure to press your government officials to eliminate inequities in the system so that we're focusing resources where they belong - on people most at risk and on people who are most likely to spread the disease. Shutting down the virus on the first category keeps hospitals from being overwhelmed. Shutting down the virus on the second category keeps spread low by knocking out superspreader people, people in roles where they can spread the disease rapidly and in large quantities, such as grocery store workers.
Encourage your friends and colleagues to avoid jumping the line, especially if they are low risk. In the end, collective action will end the pandemic sooner than any one individual's privilege to get the vaccine sooner rather than later.
The other good news is that shortly, we'll have plenty of supply. Once that happens - in a couple of months - we won't have the issues we're having now.
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A reminder of the simple daily habits we should all be taking.
1. Always wear the best mask available to you when out of your home and you'll be around other people. Respirators are back in stock at online retailers, too. Wear an N95/FFP2/KN95 that's NIOSH-approved or better mask if you can obtain it. If you can't get an N95 mask, wear a surgical mask with a cloth mask over it.
2. Get vaccinated as soon as you're able to.
3. Wash/sanitize your hands every time you are in or out of your home for any reason.
4. Stay home as much as possible. Minimize your contact with others and maintain physical distance of at LEAST 6 feet / 2 meters, preferably more. Avoid indoor places as much as you can; indoor spaces spread the disease through aerosols and distance is less effective at mitigating your risks.
5. Get your personal finances in order now. Cut all unnecessary costs.
6. Replenish your supplies as you use them. Avoid reducing your stores to pre-pandemic levels in case an outbreak causes unexpected supply chain disruptions.
7. Ventilate your home as frequently as weather and circumstances permit, except when you share close airspaces with other residences (like a window less than a meter away from a neighboring window).
8. Masks must fit properly to work. Here's how to properly fit a mask:
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Common misinformation debunked!
There is no mercury or other heavy metals in the Pfizer mRNA vaccine. https://www.technologyreview.com/2020/12/09/1013538/what-are-the-ingredients-of-pfizers-covid-19-vaccine/
There is no genomic evidence at all that COVID-19 arrived before 2020 in the United States and therefore no hidden herd immunity:
Source:
There is no evidence SARS-CoV-2 was engineered, nor that it escaped a lab somewhere.
Source: https://www.washingtonpost.com/world/2020/01/29/experts-debunk-fringe-theory-linking-chinas-coronavirus-weapons-research/
Source: https://www.nature.com/articles/s41591-020-0820-9
Source: https://www.nationalgeographic.com/science/2020/05/anthony-fauci-no-scientific-evidence-the-coronavirus-was-made-in-a-chinese-lab-cvd/
There is no evidence a flu shot increases your COVID-19 risk.
Source: https://www.factcheck.org/2020/04/no-evidence-that-flu-shot-increases-risk-of-covid-19/
Source: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa626/5842161
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A common request I'm asked is who I follow. Here's a public Twitter list of many of the sources I read.
https://twitter.com/i/lists/1260956929205112834
This list is biased by design. It is limited to authors who predominantly post in the English language. It is heavily biased towards individual researchers and away from institutions. It is biased towards those who publish or share research, data, papers, etc. I have made an attempt to follow researchers from different countries, and also to make the list reasonably gender-balanced, because multiple, diverse perspectives on research data are essential.
This is also available as an email newsletter at https://lunchtimepandemic.substack.com if you prefer the update in your inbox.